Varicose veins are enlarged, knotty, swollen, twisted veins that are visible under the skin's surface. They develop due to venous insufficiency or damaged or weak valves in the veins. This allows backward blood flow and pooling of blood in the legs.
Varicose veins are quite common, affecting up to 30% of the population worldwide. In most people, they cause little to no signs or symptoms. Spider veins, a milder form of varicose veins, do not usually cause any symptoms. In most people, spider veins are primarily a cosmetic problem. However, in some people, varicose veins can cause symptoms - they have pain and their legs ache. Such individuals need to have their varicose veins treated. If left untreated, it can lead to complications, such as skin ulcers and blood clots.
The first line of varicose vein treatments is usually lifestyle changes (diet, exercise, avoiding standing or sitting for long periods, leg elevation, and avoiding tight clothes). If these measures do not help, your doctor may recommend compression stockings. In some people, however, the varicose veins are severe and require surgery.
Please continue reading to learn more about surgical treatments for varicose veins, including large veins. These procedures can not only improve pain and other symptoms but also improve the appearance of the legs. The good news is that surgical treatment of varicose veins is often quick and easy and does not involve an extended recovery time.
Do I need surgery for varicose veins?
As noted, most people do not need any treatment for varicose veins. Many individuals can obtain relief from varicose vein symptoms by making lifestyle changes and/or wearing compression stockings (these are available at pharmacies and medical supply stores). However, if conservative measures do not provide relief to you, you might need medical treatment, or specifically, surgery for varicose veins from a vascular surgeon.
In particular, your doctor might recommend a surgical procedure for varicose veins if you have severe pain, skin ulcers, or blood clots. Studies have shown that people with varicose veins are 5 times more likely to develop deep vein thrombosis (blood clots in the veins, usually in the legs). This is a serious and potentially life-threatening condition. That's why it is important to follow your doctor's advice and not avoid varicose vein surgery if it is recommended to you.
Less commonly, people choose to undergo varicose vein treatments to improve the appearance of their legs.
What is the best surgery for varicose veins?
There are several different procedures that can be used to treat varicose veins effectively. No single treatment is best for everyone. Some of these procedures are used to treat smaller varicose veins while others are appropriate for medium sized varicose veins and large varicose veins. Keep in mind that while these treatments will address existing veins, they do not prevent varicose veins from forming in the future.
There are two categories of varicose vein surgery - procedures that close the veins and procedures that remove the veins completely.
Closing Procedures
A doctor may close off symptomatic leg veins in various ways. After the procedure, the blood flow is diverted to other blood vessels in the area. The treated varicose vein fades or is absorbed over time. Some of the procedures that can accomplish vein closing are described below.
Sclerotherapy
This procedure involves injecting a chemical solution or foam into a vein. The chemical causes the vein to become scar tissue. This helps to close varicose veins and improve blood flow. Blood flowing previously through the treated vein changes direction and starts flowing through other veins instead. The collapsed vein is reabsorbed by the body over time.
Sclerotherapy is an outpatient procedure and can be done in a doctor's office. Most patients need several treatments, spaced 4-6 weeks apart, before a vein is completely closed off. The treatment is relatively painless, similar to a needle prick from an injection. A version of this type of varicose vein surgery, microsclerotherapy, uses very fine needles to treat smaller varicose veins and relieve pain. Your doctor will advise you to wear compression stockings for a few weeks after the treatment.
Laser Treatment
Doctors use laser treatments to treat varicose veins with high-intensity laser light. Laser treatment is done in a doctor's office and does not involve any needle pricks or cuts in the skin. However, laser treatment is usually done on smaller varicose veins and may not be effective on a large vein.
Endovenous Laser Surgery
This is a more invasive form of laser treatment. During laser surgery, doctors make a small cut in the skin and insert a thin tube into the blood vessels through the cut. The thin tube has a tiny device that uses laser heat or radio waves to close the varicose vein. The procedure is done using local anesthesia (numbing medicine). Most people tolerate it well (there is minor discomfort from the injection of the numbing medicine). You can go home the same day with compression stockings on your leg.
Endoscopic Vein Surgery
This is a type of varicose vein surgery in which doctors insert a thin tube with a camera into large veins through a cut in the skin. The surgical device at the end of the tube is then threaded up to the offending vein and it is closed off. A doctor may recommend endoscopic vein surgery for severe varicose veins that are causing problems like skin ulcers or blood clot.
Removal Procedures
In some patients, a doctor may recommend that the best way to treat varicose veins is by removing them. Two types of varicose vein surgery can accomplish this.
Ambulatory Phlebectomy
This is the simpler and less invasive procedures to remove varicose veins. It is done on varicose veins close to the skin's surface. A vascular surgeon will numb the treatment area with local anesthetic and remove the affected veins through small cuts in the skin. Patients remain awake during the procedure and can usually go home the same day.
Vein Stripping and Vein Ligation
These are more invasive procedures reserved for severe varicose veins and larger veins. This type of vascular surgery is done under general anesthesia. The vascular surgeon makes cuts in the skin, ties the veins off, and removes them. The recovery time after this vascular surgery for varicose veins is 1-4 weeks. Your vascular surgeon will likely advise you to wear compression stockings for 2-6 weeks afterwards.
How serious is varicose vein vascular surgery?
It is usually possible to go home the same day after most types of varicose vein surgery. However, it can take several weeks for the treated area to heal and the swelling to go down. You may need to take 2-4 weeks off from work. The good news is that in 80% of people, varicose vein surgery can relieve symptoms such as pain, itching, and swelling. Plus, the legs look better after treatment. It is, of course, advisable not to do things that make varicose veins worse, such as wearing tight clothes or standing or sitting for long periods of time.
Serious complications such as nerve damage or thrombosis (blood clot) are very rare after a medical procedure for varicose veins. However, side effects like pain, infection, bleeding, changes in skin color, and scarring occur in about 15% of people. In general, endovenous laser treatment is less likely to cause complications and is preferred nowadays if the size of the varicose veins is appropriate for this treatment. Also, compared to surgery, sclerotherapy is associated with a lower risk of side effects and faster recovery.
It is worth noting that while these treatments will address existing varicose veins, new spider veins and varicose veins can develop after surgery. Studies have found that roughly 30% of people who had varicose vein surgery developed new varicose veins within 2 years.
Can you walk after vein surgery?
Yes, regular walking is recommended after varicose vein surgery. Walking during the healing process and afterwards strengthens the calf muscles, promotes good circulation, and helps to prevent blood clots in the legs. The added advantage is that walking can help you lose weight (being overweight is a risk factor for varicose veins).
How long does it take to recover from varicose vein surgery?
The recovery time after varicose vein surgery depends on the type of procedure and the number of veins treated. In general, the recovery time after sclerotherapy and laser treatments is 1-2 weeks. You can return to work immediately after the treatment but may have some residual pain and swelling for a couple of weeks. You need 2-4 weeks of recovery after varicose vein stripping.
Which varicose vein procedure is right for me?
A vascular surgeon is the best person to help you decide on the best varicose vein surgery for you. They will perform a physical exam and order blood tests and other diagnostic tests. Before recommending a treatment to you, they will take into account several factors, such as your age, overall health status, the location and severity of your varicose veins, the severity of your symptoms, and your ability to tolerate specific treatments.
Finding a provider for varicose vein treatment
The MeTime app makes it easy to find providers for varicose vein surgery. You can chat with experts, share photos, do a video consultation, and get quotes. And when you're ready, you can even pay securely and book your office appointment through the app. Download the MeTime app today and find out more about varicose vein treatments.
